Prostate cancer screening: Should I have a PSA test?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Your options

Key points to remember

Many men who are older than 50 have this test as part of their
regular checkups. But experts disagree on whether PSA tests should be
recommended for all men.

There are other causes of a high PSA level
besides prostate cancer. After receiving a high PSA result, men often have more
testing and then find that cancer is not the cause.

Prostate cancer
usually grows slowly. In some cases, it never affects a man's
health.

Sometimes prostate cancer grows or spreads quickly. Unless
it is treated, it leads to death.

Prostate cancer that is found
early can usually be cured.

Treatment for prostate cancer can cause
serious side effects (loss of bladder control, not being able to have an
erection). If you have a PSA test and it leads to a diagnosis of prostate
cancer, you'll face a hard decision about whether to have treatment and deal
with its side effects.

After an abnormal PSA test, your next choice is to have a
biopsy to look for signs of prostate cancer. If you learn that you have cancer,
you then make choices about treatment.

If you have a family
history of prostate cancer, your risk of getting it is higher than
average.

Prostate cancer is the
abnormal growth of cells in the tissues of the
prostate gland. It is the most common cancer in men. Most men who get it are
older than 65.

Unlike many other cancers, it is usually
slow-growing. Most men will die with prostate cancer but
not because of prostate cancer.1 This doesn't mean that you will get it. Each person is
different, and tests can't show who will get prostate cancer and who
won't.

Early prostate cancer usually doesn't cause symptoms. When
prostate cancer is found early, before it has spread outside the prostate
gland, it may be cured with radiation or surgery to remove the prostate. As
prostate cancer grows or spreads, symptoms may develop, including urinary
problems (such as blood in the urine) and bone pain.

If your
father, brother, or son has had prostate cancer, your chances of getting it are
higher than average.2 Men whose families carry the
gene changes that cause breast cancer (BRCA1 or BRCA2) are thought to have a
higher risk for prostate cancer.3 African-American men
have higher rates of prostate cancer and are more than twice as likely to die
from it as men in other racial and ethnic groups in the United States.3

The
prostate-specific antigen (PSA) test is a blood test.
PSA is released into a man's blood by the cells of his prostate gland. Low
amounts of PSA may be found in the blood of healthy men. The amount of PSA in
the blood normally increases as a man's prostate enlarges with age. And it
increases after ejaculation and after trauma to the prostate caused by such
things as a long bike ride. It is also increased by inflammation of the
prostate gland (prostatitis) and by prostate cancer.

The
PSA test is usually done along with a digital rectal exam. Together they can
help identify men who may have prostate cancer and should consider further
tests.

A high
PSA result can be the first warning sign of prostate cancer. A high PSA can
signal a higher risk of getting prostate cancer in the future.4 But a high PSA can also be linked to other causes that
aren't cancer.

The amount of PSA in the blood normally increases
as a man's prostate enlarges with age. But when you have prostate cancer, your
PSA level increases even more over time.

The PSA test and digital rectal exam can suggest a
problem when there is not one. This is called a
false-positive result. Only about 20 to 30 out of 100
men who have a PSA test result greater than 4.0 ng/mL actually have prostate
cancer, while 70 to 80 of them don't have prostate cancer.

The prostate
naturally gets bigger as a man gets older. More than half of all men who are
older than 50 have an enlarged prostate. This affects the PSA level, making it
less accurate as a way to detect cancer.

Because several other
things can make a PSA level go up—for example, ejaculation or an infection in
the prostate—your doctor may advise you to have another PSA test later before
you make any further decisions.

If your PSA test suggests that you
may have prostate cancer, your doctor may recommend a
biopsy, which is the only way to make sure that you
have prostate cancer. If the biopsy finds cancer, you must decide how or
whether to treat it.

A few prostate cancers grow fast. Men who
have fast-growing cancers are more likely to die from prostate cancer than men
who have slower-growing cancers. A PSA test can't accurately tell which type of
prostate cancer a man has. But in men who have not been diagnosed with prostate
cancer, PSA velocity can show that there is a problem
that needs further testing. PSA velocity is measured by looking at the rate of
change in PSA levels over 2 or 3 years. PSA levels rise faster in men with
prostate cancer than they do in men with enlarged prostates.

Most medical experts
say that men age 50 or older should talk to their doctors about the pros and
cons of PSA testing so that they can make their own decisions.

Some experts worry that PSA testing for prostate cancer begins a process
that can force a man to make hard decisions and can lead to other health
problems that are caused by the treatment for prostate cancer. Here's what some
experts say:

The
U.S. Preventive Services Task Force (USPSTF) and most
medical groups say most men should not be given PSA tests as part of routine
medical checkups. Instead, each man should talk to his doctor to see if he
should have the test.

The American Cancer Society recommends that
if you are in good health and expect to live at least 10 more years, you should
be offered annual PSA tests beginning at age 50.

The American
Cancer Society recommends testing if you are an African-American man who is 45
or older.

The American Cancer Society says you could start regular
PSA testing at age 40 if you have several close relatives who had prostate
cancer before age 65.

The USPSTF says that men who are 75 or older
should not be tested and that younger men should discuss the pros and cons of
PSA testing before being tested. The USPSTF also says that men younger than 75
with long-term medical problems or who expect to live less than 10 years are
unlikely to benefit from testing.

Personal stories about having a prostate-specific antigen (PSA) test to screen for prostate cancer

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I have two
children who are in high school right now, and both plan to go to college. It's
important to me to provide for them and ensure that they have the money they
need to finish their education. If I found out I had cancer, I would try any
treatment that might offer me a chance to live longer, even if it has side
effects. I'm going to have the PSA test.

Eric, age 56

For me,
there is still too much uncertainty about the benefits of the PSA test. I tend
to stay away from things that aren't yet proven to work, even when I know there
is a chance that we might someday find out there is a benefit. I'm willing to
take that chance. Because I want to avoid the risks of inexact test results and
additional tests, I'm not going to have the test.

Mike, age 62

My health is
great. I still run, play tennis, and travel a lot. At my age, you start to see
friends getting sick and dying of one thing or another, and it makes you start
to think about your own health more. I know that the PSA test isn't perfect,
but I want to have every chance I can to treat cancer early if I have
it.

Jacob, age
68

I've done some reading on this subject, and
I know that I'm a lot more likely to die from my heart disease than from
prostate cancer. Right now I'm focusing my efforts on controlling my blood
pressure and cholesterol because I know that treating those things can help me
live longer and better. I know that if I had the PSA test and it was high, I
would just worry and be stressed out. That's not good for my heart
either!

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have a PSA test

Reasons not to have a PSA test

I want to know if I have cancer in my prostate.

I don't feel the need to know if I have prostate cancer.

More important

Equally important

More important

Having prostate cancer and not treating it scares me more than the urinary and erection problems that cancer treatment may cause.

I worry that I might end up with urinary and erection problems if I have prostate cancer treatment.

More important

Equally important

More important

I would do anything to fight prostate cancer, even if the side effects of treatment affect my quality of life.

I think the additional testing and treatment that might follow a positive test result would do me more harm than good.

More important

Equally important

More important

I want to know if I have prostate cancer.

I don't want to know if I have prostate cancer, because it may never affect my health.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having a PSA test

NOT having a PSA test

Leaning toward

Undecided

Leaning toward

What else do you need to make your decision?

Check the facts

1.

Should all men over 50 have regular PSA tests?

YesNo, that's wrong. Although many men older than 50 have this test as part of their regular checkups, experts disagree on whether PSA tests are necessary for all men.

NoYou're right. Although many men older than 50 have this test as part of their regular checkups, experts disagree on whether PSA tests are necessary for all men.

I'm not sureIt may help to go back and read "Key points to remember." Although many men older than 50 have this test as part of their regular checkups, experts disagree on whether PSA tests are necessary for all men.

2.

Is it important to think about the side effects of prostate cancer treatment when making this decision?

YesIt's true. Prostate cancer treatment can cause loss of bladder control and not being able to have an erection. Having a PSA test could lead to your having to decide whether to have that treatment.

NoSorry, that's wrong. Prostate cancer treatment can cause loss of bladder control and not being able to have an erection. Having a PSA test could lead to your having to decide whether to have that treatment.

I'm not sureIt may help to go back and read "Compare your options." Prostate cancer treatment can cause loss of bladder control and not being able to have an erection. Having a PSA test could lead to your having to decide whether to have that treatment.

3.

Can a PSA test help find prostate cancer early, when it is usually curable?

YesYou're right. When prostate cancer is found early, before it has spread outside the prostate gland, it may be cured with radiation or surgery to remove the prostate.

NoNo, that's wrong. When prostate cancer is found early, before it has spread outside the prostate gland, it may be cured with radiation or surgery to remove the prostate.

I'm not sureIt may help to go back and read "What is prostate cancer?" When prostate cancer is found early, before it has spread outside the prostate gland, it may be cured with radiation or surgery to remove the prostate.

Decide what's next

1.

Do you understand the options available to you?

2.

Are you clear about which benefits and side effects matter most to you?

Prostate cancer screening: Should I have a PSA test?

You can use it to talk with your doctor or loved ones about your decision.

Get the facts

Compare your options

What matters most to you?

Where are you leaning now?

What else do you need to make your decision?

1. Get the facts

Your options

Have a PSA test to check for prostate
cancer.

Do not have a PSA test to check for prostate cancer.

Key points to remember

Many men who are older than 50 have this test as part of their
regular checkups. But experts disagree on whether PSA tests should be
recommended for all men.

There are other causes of a high PSA level
besides prostate cancer. After receiving a high PSA result, men often have more
testing and then find that cancer is not the cause.

Prostate cancer
usually grows slowly. In some cases, it never affects a man's
health.

Sometimes prostate cancer grows or spreads quickly. Unless
it is treated, it leads to death.

Prostate cancer that is found
early can usually be cured.

Treatment for prostate cancer can cause
serious side effects (loss of bladder control, not being able to have an
erection). If you have a PSA test and it leads to a diagnosis of prostate
cancer, you'll face a hard decision about whether to have treatment and deal
with its side effects.

After an abnormal PSA test, your next choice is to have a
biopsy to look for signs of prostate cancer. If you learn that you have cancer,
you then make choices about treatment.

If you have a family
history of prostate cancer, your risk of getting it is higher than
average.

FAQs

What is prostate cancer?

Prostate cancer is the
abnormal growth of cells in the tissues of the
prostate gland . It is the most common cancer in men. Most men who get it are
older than 65.

Unlike many other cancers, it is usually
slow-growing. Most men will die with prostate cancer but
not because of prostate cancer.1 This doesn't mean that you will get it. Each person is
different, and tests can't show who will get prostate cancer and who
won't.

Early prostate cancer usually doesn't cause symptoms. When
prostate cancer is found early, before it has spread outside the prostate
gland, it may be cured with radiation or surgery to remove the prostate. As
prostate cancer grows or spreads, symptoms may develop, including urinary
problems (such as blood in the urine) and bone pain.

If your
father, brother, or son has had prostate cancer, your chances of getting it are
higher than average.2 Men whose families carry the
gene changes that cause breast cancer (BRCA1 or BRCA2) are thought to have a
higher risk for prostate cancer.3 African-American men
have higher rates of prostate cancer and are more than twice as likely to die
from it as men in other racial and ethnic groups in the United States.3

What is a PSA test?

The
prostate-specific antigen (PSA) test is a blood test.
PSA is released into a man's blood by the cells of his prostate gland. Low
amounts of PSA may be found in the blood of healthy men. The amount of PSA in
the blood normally increases as a man's prostate enlarges with age. And it
increases after ejaculation and after trauma to the prostate caused by such
things as a long bike ride. It is also increased by inflammation of the
prostate gland (prostatitis) and by prostate cancer.

The
PSA test is usually done along with a digital rectal exam. Together they can
help identify men who may have prostate cancer and should consider further
tests.

What kind of results can a PSA test show?

A high
PSA result can be the first warning sign of prostate cancer. A high PSA can
signal a higher risk of getting prostate cancer in the future.4 But a high PSA can also be linked to other causes that
aren't cancer.

The amount of PSA in the blood normally increases
as a man's prostate enlarges with age. But when you have prostate cancer, your
PSA level increases even more over time.

The PSA test and digital rectal exam can suggest a
problem when there is not one. This is called a
false-positive result. Only about 20 to 30 out of 100
men who have a PSA test result greater than 4.0 ng/mL actually have prostate
cancer, while 70 to 80 of them don't have prostate cancer.

What does the PSA test NOT tell you?

The prostate
naturally gets bigger as a man gets older. More than half of all men who are
older than 50 have an enlarged prostate. This affects the PSA level, making it
less accurate as a way to detect cancer.

Because several other
things can make a PSA level go up—for example, ejaculation or an infection in
the prostate—your doctor may advise you to have another PSA test later before
you make any further decisions.

If your PSA test suggests that you
may have prostate cancer, your doctor may recommend a
biopsy, which is the only way to make sure that you
have prostate cancer. If the biopsy finds cancer, you must decide how or
whether to treat it.

A few prostate cancers grow fast. Men who
have fast-growing cancers are more likely to die from prostate cancer than men
who have slower-growing cancers. A PSA test can't accurately tell which type of
prostate cancer a man has. But in men who have not been diagnosed with prostate
cancer, PSA velocity can show that there is a problem
that needs further testing. PSA velocity is measured by looking at the rate of
change in PSA levels over 2 or 3 years. PSA levels rise faster in men with
prostate cancer than they do in men with enlarged prostates.

How does age affect the decision to have a PSA test?

Your chance of getting prostate cancer increases as you age. Men who are
younger than 75 and who do not have serious health problems may gain the most
from early detection and treatment.

What do the experts recommend?

Most medical experts
say that men age 50 or older should talk to their doctors about the pros and
cons of PSA testing so that they can make their own decisions.

Some experts worry that PSA testing for prostate cancer begins a process
that can force a man to make hard decisions and can lead to other health
problems that are caused by the treatment for prostate cancer. Here's what some
experts say:

The
U.S. Preventive Services Task Force (USPSTF) and most
medical groups say most men should not be given PSA tests as part of routine
medical checkups. Instead, each man should talk to his doctor to see if he
should have the test.

The American Cancer Society recommends that
if you are in good health and expect to live at least 10 more years, you should
be offered annual PSA tests beginning at age 50.

The American
Cancer Society recommends testing if you are an African-American man who is 45
or older.

The American Cancer Society says you could start regular
PSA testing at age 40 if you have several close relatives who had prostate
cancer before age 65.

The USPSTF says that men who are 75 or older
should not be tested and that younger men should discuss the pros and cons of
PSA testing before being tested. The USPSTF also says that men younger than 75
with long-term medical problems or who expect to live less than 10 years are
unlikely to benefit from testing.

Why might your doctor recommend a PSA test?

Your
doctor might recommend a PSA test if:

You are in your 50s or 60s and are in good
health.

Your doctor wants to keep track of changes in your PSA
level.

You are an African American or a Jamaican of African descent,
which means that you have a greater chance of getting the kind of prostate
cancer that grows and spreads.

Your father, brother, or son got prostate cancer before age
65.

2. Compare your options

Have a PSA test

Don't have a PSA test

What is usually involved?

It's a simple blood test. A
needle is used to take a sample of blood from your arm.

You have regular checkups
that don't include this test.

What are the benefits?

A PSA test can help find
prostate cancer early, while it is small and usually curable.

You avoid testing that
could lead to cancer treatment that can cause other health problems, especially
loss of bladder control and not being able to have an erection.

What are the risks and side effects?

Testing could lead
you to hard decisions about further testing and treatment.

Testing
could lead to cancer treatment that can cause loss of bladder control and not
being able to have an erection.

You may have
treatable prostate cancer without knowing it.

Sometimes prostate cancer grows quickly. If this type of prostate
cancer it is not found early, it can shorten your life.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about having a prostate-specific antigen (PSA) test to screen for prostate cancer

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I have two children who are in high school right now, and both plan to go to college. It's important to me to provide for them and ensure that they have the money they need to finish their education. If I found out I had cancer, I would try any treatment that might offer me a chance to live longer, even if it has side effects. I'm going to have the PSA test."

— Eric, age 56

"For me, there is still too much uncertainty about the benefits of the PSA test. I tend to stay away from things that aren't yet proven to work, even when I know there is a chance that we might someday find out there is a benefit. I'm willing to take that chance. Because I want to avoid the risks of inexact test results and additional tests, I'm not going to have the test."

— Mike, age 62

"My health is great. I still run, play tennis, and travel a lot. At my age, you start to see friends getting sick and dying of one thing or another, and it makes you start to think about your own health more. I know that the PSA test isn't perfect, but I want to have every chance I can to treat cancer early if I have it."

— Jacob, age
68

"I've done some reading on this subject, and I know that I'm a lot more likely to die from my heart disease than from prostate cancer. Right now I'm focusing my efforts on controlling my blood pressure and cholesterol because I know that treating those things can help me live longer and better. I know that if I had the PSA test and it was high, I would just worry and be stressed out. That's not good for my heart either!"

— Pieter, age
67

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have a PSA test

Reasons not to have a PSA test

I want to know if I have cancer in my prostate.

I don't feel the need to know if I have prostate cancer.

More important

Equally important

More important

Having prostate cancer and not treating it scares me more than the urinary and erection problems that cancer treatment may cause.

I worry that I might end up with urinary and erection problems if I have prostate cancer treatment.

More important

Equally important

More important

I would do anything to fight prostate cancer, even if the side effects of treatment affect my quality of life.

I think the additional testing and treatment that might follow a positive test result would do me more harm than good.

More important

Equally important

More important

I want to know if I have prostate cancer.

I don't want to know if I have prostate cancer, because it may never affect my health.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having a PSA test

NOT having a PSA test

Leaning toward

Undecided

Leaning toward

5. What else do you need to make your decision?

Check the facts

1.
Should all men over 50 have regular PSA tests?

Yes

No

I'm not sure

You're right. Although many men older than 50 have this test as part of their regular checkups, experts disagree on whether PSA tests are necessary for all men.

2.
Is it important to think about the side effects of prostate cancer treatment when making this decision?

Yes

No

I'm not sure

It's true. Prostate cancer treatment can cause loss of bladder control and not being able to have an erection. Having a PSA test could lead to your having to decide whether to have that treatment.

3.
Can a PSA test help find prostate cancer early, when it is usually curable?

Yes

No

I'm not sure

You're right. When prostate cancer is found early, before it has spread outside the prostate gland, it may be cured with radiation or surgery to remove the prostate.

Decide what's next

1.
Do you understand the options available to you?

Yes

No

2.
Are you clear about which benefits and side effects matter most to you?

Yes

No

3.
Do you have enough support and advice from others to make a choice?

Yes

No

Certainty

1.
How sure do you feel right now about your decision?

Not sure at all

Somewhat sure

Very sure

2.
Check what you need to do before you make this decision.

I'm ready to take action.

I want to discuss the options with others.

I want to learn more about my options.

3.
Use the following space to list questions, concerns, and next steps.

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